Healthcare Provider Details

I. General information

NPI: 1881886653
Provider Name (Legal Business Name): CYNTHIA G BOYNTON LICENSED DIETICIAN N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LINCOLN WAY EAST
MISHAWAKA IN
46544
US

IV. Provider business mailing address

410 LINCOLN WAY EAST
MISHAWAKA IN
46544
US

V. Phone/Fax

Practice location:
  • Phone: 574-259-5653
  • Fax: 574-259-5654
Mailing address:
  • Phone: 574-259-5653
  • Fax: 574-259-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: